Congress extends telehealth coverage for 151 days after PHE; Patients can be at home | Healthcare Compliance Association (HCCA)
Congress breathed new life into telehealth services, at least for five months after the end of the public health emergency (PHE) COVID-19, in the $1.5 trillion bill that funds the government federal government until September and is sending emergency aid to Ukraine. The bill extends Medicare coverage to telehealth services delivered to patients’ homes, audio-only telehealth services, and other flexibilities that are products of the PHE and its waivers. It was passed by the House on March 9 and the Senate on March 10 and is expected to be signed quickly by President Joe Biden.
“It’s a huge ‘we love telehealth’ vote,” said Allison Kassir, senior government relations adviser at King & Spalding in Washington, DC. Without this measure in the Consolidated Appropriations Act (CAA) of 2022, providers and patients suffered a stark loss. of broad Medicare coverage for telehealth services at the end of the PHE, which could be as early as mid-April or possibly mid-July, depending on whether the improving picture of COVID-19 continues darkens again. “It’s a steep cliff,” Kassir noted. “Unless you legislate it, there is no phasing out.”
The CAA’s telehealth provisions guarantee Medicare coverage of basic flexibilities for 151 days beginning on the first day after PHE ends, Kassir said. “There’s such bipartisan support for this,” and in recent years that’s a rare thing, she noted. But telehealth “has been demystified”. The two-year COVID-19 exemption from certain Medicare telehealth requirements “has been such a good test of this means of care delivery.” The CAA provisions also set the stage for a stand-alone bill that could permanently expand telehealth services, although it is expected to include “safeguards” and other integrity measures. of the program, Kassir said.
Congress has covered a lot of telehealth ground. “The majority of PHE flexibilities are captured in this legislative extension,” said Richelle Marting, an attorney in Olathe, Kansas. Perhaps the broadest trait is the bill’s definition of “originating site” to refer to any site where a “telehealth-eligible person” is located when the services are provided. Prior to the PHE, the home-site requirement generally limited Medicare coverage to services provided to patients in hospitals and other delivery locations (not in patients’ homes) by practitioners at remote sites (e.g., doctors). The COVID-19 waivers set aside the site-of-origin requirement for telehealth services, allowing them to be provided in patients’ homes, and the legislation would maintain this flexibility 151 days after the end of the PHE. Marting said this appears to be even broader than the waivers, allowing Medicare coverage of telehealth services provided wherever the patient is located (e.g., coffee shop, patient’s car, library), resolving the concerns of many providers as to whether these locations qualify as “domiciled” under the current PHE waivers.
But the legislation does not specifically authorize Medicare to pay the originating site fee for any new originating site location covered by the legislation. She explained that Congress authorized the continuation for five months of payments to remote site practitioners for telehealth services provided to patients in their homes and other locations that are not the usual pre-PHE origin sites. , but “locations that were not statutorily identified as Originating Sites prior to the PHE cannot charge an Originating Site Fee if they only qualify as Originating Sites after of this new legislative extension. For example, “if there is a retail clinic or pharmacy, the patient could be at those locations and still receive telehealth service, and the remote site professional may charge for it, but the clinic or retail pharmacy could not charge an origin site fee,” Marting said. “The difference is that before COVID, the entire telehealth service was not allowed if the patient was not at an eligible source site.”
Audio-only telehealth lives after PHE
Also in the legislation, Medicare coverage of audio-only telehealth services, a benefit stemming from the COVID-19 pandemic, remains afloat for five months after the PHE ends. Without this extension, the cover would have disappeared. Another flexibility that was scheduled to expire at the end of PHE but will continue through CAA 2022 is recertification of palliative care via telehealth.
Congress also continued to include physical therapists, occupational therapists, speech language pathologists, and audiologists in the definition of remote site practitioners, as the PHE waivers currently allow. And rural health centers and federally licensed health centers are now eligible as remote site practitioners for five months after PHE ends.
In another move, Congress changed the in-person requirement affecting telehealth mental health services. The in-person requirement is not in the waivers; it stems from legislation creating new benefits of telehealth for mental health services. The 2022 Medicare Physician Fee Schedule Rule interpreted provisions of the Prevention of Substance Use Disorders Act that promotes recovery and treatment of opioids for patients and communities who release substance use disorders to Substance Use (SUD) and Co-occurring Mental Health Disorders geographical boundaries and allow the patient’s home to be an originating site for telehealth, and this remains true when the PHE ends.
CAA 2021 has extended this coverage beyond the SUDs to enable the home to be a site of origin for the diagnosis, assessment and treatment of all mental health disorders, not just those that coexist with a SOUTH. “A significant difference between expanded services and the original SUD telehealth coverage, however, was the requirement for an in-person visit within six months of the first telehealth service and subsequent in-person visits every 12 months if providers were to rely on the provisions of the Consolidated Appropriations Act of 2021 allowing these services outside of rural areas and to patients at home,” Marting said. “These requirements would come into effect after the PHE ends, but do not apply if the telehealth service would already be covered under the regular Medicare telehealth rules.”
Now, Congress has delayed the in-person visitation requirement for telebehavior patients who are at home or outside a rural area. (Medicare telehealth coverage normally only covers telehealth services when provided to patients in rural areas, but this was also canceled during PHE).
Expenses, program integrity is on their mind
While the legislation contains no program integrity requirements, it directs the Medicare Payment Advisory Commission (MedPAC) to study the expansion of telehealth resulting from COVID-19 PHE and increased spending and report to Congress with legislative and technical recommendations next year. . Congress also tasked the HHS Office of Inspector General to report on program integrity risks, with recommendations to prevent fraud, waste, and abuse.
“My antenna started shaking when the OIG was instructed to report,” Marting said. “As we move away from PHE status, this indicates that there will likely be more review to meet all documentation requirements for telehealth.” For example, CMS previously added audio-only telebehavioral services as a permanent benefit, but Medicare only pays when “the beneficiary is unable to use, does not want to use, or does not have access to audio/video technology.” bidirectional. “This is difficult from an operational and medical perspective, as audio-only telebehavioral health is only covered when the patient is at home and documentation must substantiate why the beneficiary was unable to use or wouldn’t use audio-visual technology, she said. . “These requirements could be prime targets for program integrity review activities.”
Program integrity guardrails will likely come into play if Congress passes a more permanent expansion of telehealth, Kassir said. This includes the Telehealth Extension and Evaluation Act, a bill sponsored by Sens. Catherine Cortez Masto, D-Nev., and Todd Young, R-Ind., who are extending telehealth flexibilities for two years.
The 151 days provided by the CAA shows ‘there was no agreement on how to move forward on safeguards’, but Congress didn’t want patients falling off a cliff after PHE , Kassir said. The leeway available to providers and patients now gives them a chance to make Congress understand the need to balance safeguards in future legislation with the risks they might prevent patients from accessing telehealth services, she noted. “If I was a vendor, I’d be on alert for sample requirements,” Kassir said. There could be “unintended consequences” to program integrity measures. “By trying to fight fraud, you risk hurting people who are trying to benefit from telehealth.”
1 Printed Rules Committee 117–35 Text of House Amendment to Senate Amendment to HR 2471, March 8, 2022, https://bit.ly/3tRBkO4.
2 health insurance program; CY 2022 payment policies under the Physician Fee Schedule and other changes to Part B payment policies; Medicare Shared Savings Program Requirements; Updates to the Supplier Registration Policy; and Prepaid and Post-Payment Medical Review Requirements, 86 Fed. Reg. 64,996 (November 19, 2021), https://bit.ly/3k020YY.
3 Catherine Cortez Masto, “Cortez Masto & Young Introduce Bipartisan Legislation to Extend Coverage of Telehealth Services for Seniors,” press release, February 7, 2022, https://bit.ly/34A12hv.